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vortioxetine

Adjunctive therapy

Brands: Trintellix

Last reviewed 2025-10-05

Reviewed by PsychMed Editorial Team.

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Quick answers

  • What is vortioxetine?

    Vortioxetine (Trintellix) is a multimodal antidepressant approved for adult major depressive disorder; guidelines highlight it as a later-line option when first-line SSRIs/SNRIs are ineffective or poorly tolerated, and when cognitive symptoms persist.[label_vortioxetine][apa_mdd_2023][canmat_mdd_2024]

  • What is Trintellix?

    Trintellix is a brand name for vortioxetine.

  • What is Trintellix (vortioxetine) used for?

    Label indications include: Major depressive disorder.

  • What drug class is Trintellix (vortioxetine)?

    Multimodal antidepressant: SERT inhibition plus 5-HT receptor modulation.

  • What strengths does Trintellix (vortioxetine) come in?

    Film-coated tablets: 5 mg, 10 mg, 15 mg, 20 mg.

Snapshot

  • Class: Adjunctive therapy
  • Common US brands: Trintellix
  • Therapeutic drug monitoring not routinely recommended.
  • Last reviewed: 2025-10-05

Label indications

Major depressive disorder.

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Clinical Highlights

Vortioxetine (Trintellix) is a multimodal antidepressant approved for adult major depressive disorder; guidelines highlight it as a later-line option when first-line SSRIs/SNRIs are ineffective or poorly tolerated, and when cognitive symptoms persist.[label_vortioxetine][apa_mdd_2023][canmat_mdd_2024]. The compare view and the vortioxetine evidence feed can help line up cognitive benefits, GI tolerability, and sexual side effect profiles before adjusting therapy.

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  • Weight-neutral metabolism and a relatively low interaction burden make vortioxetine attractive for patients already receiving antipsychotics or mood stabilizers, although cost remains a barrier because only authorized generics are available.
  • Consider when executive dysfunction or residual cognitive complaints remain problematic; provide nausea mitigation strategies during initiation.
  • Major depressive disorder (FDA 2013)
  • Generic: Authorized generic distribution is limited; most pharmacies dispense brand Trintellix as of 2025.

Dosing & Formulations

Film-coated tablets: 5 mg, 10 mg, 15 mg, 20 mg. Initiate 10 mg once daily; increase to 20 mg once daily after at least 7 days if tolerated.[label_vortioxetine].

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  • When co-administered with strong CYP2D6 inhibitors (bupropion, fluoxetine, paroxetine, quinidine) or in known poor metabolizers, consider 5 mg once daily with a maximum of 10 mg daily.[label_vortioxetine]
  • Extended taper is usually unnecessary due to the long half-life, but stepping down to 10 mg for one week before stopping can minimize transient discontinuation symptoms.

Monitoring & Risks

Boxed warning: Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults—monitor closely during initiation and dose changes.[label_vortioxetine]. Nausea: Dose-dependent; typically resolves within 1–2 weeks. Taking with food or bedtime dosing can improve tolerability.[label_vortioxetine].

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  • Headache: Usually mild and self-limited.
  • Dizziness: Counsel patients to rise slowly to reduce fall risk.
  • Diarrhea or constipation: Monitor hydration; adjust diet or add symptomatic therapy if persistent.
  • Pruritus or flushing: Occasional; generally does not require discontinuation.

Drug Interactions

Strong CYP2D6 inhibitors increase vortioxetine exposure—do not exceed 10 mg/day and monitor for nausea or dizziness.[label_vortioxetine]. Enzyme inducers (carbamazepine, rifampin) may reduce efficacy; consider higher doses (up to 20 mg) while monitoring response or choose an alternative.[label_vortioxetine].

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  • Contraindicated with MAOIs, linezolid, or IV methylene blue—allow a 14-day washout to reduce serotonin syndrome risk.[label_vortioxetine]
  • Additive bleeding risk with NSAIDs, antiplatelets, or anticoagulants—consider gastroprotection and counsel on bleeding signs.

Practice Notes

Randomized studies (FOCUS, CONNECT) suggest improvements in cognitive domains such as processing speed and executive function; track functional gains over time.[thase2016_vortioxetine]. Because nausea is the primary tolerability barrier, provide supportive care (ginger, antiemetics PRN) and consider slower titration in sensitive patients.

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  • Mania/hypomania can emerge in bipolar spectrum disorders—screen prior to initiation and loop in the bipolar disorder hub for relapse prevention strategies if mood elevation appears.

References

  1. Trintellix (vortioxetine) prescribing information — DailyMed (2024)
  2. Vortioxetine: a review of its use in major depressive disorder — CNS Drugs (2014)
  3. Efficacy of vortioxetine on cognitive functioning in depression: FOCUS study — International Journal of Neuropsychopharmacology (2016)
  4. Comparative efficacy and acceptability of 21 antidepressant drugs for major depressive disorder — The Lancet (2018)Meta-analysisdepressionefficacy
  5. APA Clinical Practice Guideline for the Treatment of Depression — American Psychiatric Association (2023)Guidelinedepressionclinical
  6. CANMAT 2024 Clinical Guidelines for Major Depressive Disorder — Canadian Journal of Psychiatry (2024)
Vortioxetine (Trintellix) — Summary — PsychMed